Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement
Background. We sought to characterize the level of LDL-C control and identify opportunities for improvement and characteristics of patients who were undertreated. Methods. Study patients were from a large multihospital system, age <90, with documentation of at least two encounters with a CAD diag...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/7537510 |
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| author | Gary J. Martin Meron Teklu Edwin Mandieka Joe Feinglass |
| author_facet | Gary J. Martin Meron Teklu Edwin Mandieka Joe Feinglass |
| author_sort | Gary J. Martin |
| collection | DOAJ |
| description | Background. We sought to characterize the level of LDL-C control and identify opportunities for improvement and characteristics of patients who were undertreated. Methods. Study patients were from a large multihospital system, age <90, with documentation of at least two encounters with a CAD diagnosis or procedure before a first measured LDL-C level and a last recorded LDL-C measurement over a minimum six-month (median = 22 months, IQR = 15–26 months) follow-up from January 2017 to September 2019. Linear regression analysis for last recorded LDL-C level was used to analyze the effects of statin intensity and patient characteristics. Results. Among 15,111 eligible patients, mean age was 68.4 (SD = 10.8), 68.7% were male, and 79.4% were non-Hispanic White. At follow-up, 87.8% of patients were prescribed a statin, 9.7% were on ezetimibe, and 0.5% were on a PCSK9 inhibitor. Mean LDL-C at follow-up was 75.6 mg/dL and 45.5% of patients were on high-intensity treatment. Higher LDL-C values were associated with female sex, younger patients, non-Hispanic Black patients, high poverty or out of state zip code, Medicaid, or angina as the qualifying diagnosis. For 332 clinicians with >10 patients in the cohort, mean last recorded LDL-C values ranged from 47 to 102 mg/dL. Conclusions. There were important variations in LDL-C control between patients in our health system with the same indication for treatment. Variation in treatment among physicians is an area ripe for quality improvement interventions. This study may be easily reproduced by other medical centers and used for highlighting both patient and physician opportunities for improvement. |
| format | Article |
| id | doaj-art-a508a51fd0c8414e98b1da28d61ff725 |
| institution | Kabale University |
| issn | 2090-0597 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiology Research and Practice |
| spelling | doaj-art-a508a51fd0c8414e98b1da28d61ff7252025-02-03T05:50:31ZengWileyCardiology Research and Practice2090-05972022-01-01202210.1155/2022/7537510Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for ImprovementGary J. Martin0Meron Teklu1Edwin Mandieka2Joe Feinglass3Department of MedicineNorthwestern University Feinberg School of MedicineInternal Medicine ResidentDivision of General Internal Medicine and GeriatricsBackground. We sought to characterize the level of LDL-C control and identify opportunities for improvement and characteristics of patients who were undertreated. Methods. Study patients were from a large multihospital system, age <90, with documentation of at least two encounters with a CAD diagnosis or procedure before a first measured LDL-C level and a last recorded LDL-C measurement over a minimum six-month (median = 22 months, IQR = 15–26 months) follow-up from January 2017 to September 2019. Linear regression analysis for last recorded LDL-C level was used to analyze the effects of statin intensity and patient characteristics. Results. Among 15,111 eligible patients, mean age was 68.4 (SD = 10.8), 68.7% were male, and 79.4% were non-Hispanic White. At follow-up, 87.8% of patients were prescribed a statin, 9.7% were on ezetimibe, and 0.5% were on a PCSK9 inhibitor. Mean LDL-C at follow-up was 75.6 mg/dL and 45.5% of patients were on high-intensity treatment. Higher LDL-C values were associated with female sex, younger patients, non-Hispanic Black patients, high poverty or out of state zip code, Medicaid, or angina as the qualifying diagnosis. For 332 clinicians with >10 patients in the cohort, mean last recorded LDL-C values ranged from 47 to 102 mg/dL. Conclusions. There were important variations in LDL-C control between patients in our health system with the same indication for treatment. Variation in treatment among physicians is an area ripe for quality improvement interventions. This study may be easily reproduced by other medical centers and used for highlighting both patient and physician opportunities for improvement.http://dx.doi.org/10.1155/2022/7537510 |
| spellingShingle | Gary J. Martin Meron Teklu Edwin Mandieka Joe Feinglass Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement Cardiology Research and Practice |
| title | Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement |
| title_full | Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement |
| title_fullStr | Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement |
| title_full_unstemmed | Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement |
| title_short | Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement |
| title_sort | low density lipoprotein cholesterol levels in coronary artery disease patients opportunities for improvement |
| url | http://dx.doi.org/10.1155/2022/7537510 |
| work_keys_str_mv | AT garyjmartin lowdensitylipoproteincholesterollevelsincoronaryarterydiseasepatientsopportunitiesforimprovement AT meronteklu lowdensitylipoproteincholesterollevelsincoronaryarterydiseasepatientsopportunitiesforimprovement AT edwinmandieka lowdensitylipoproteincholesterollevelsincoronaryarterydiseasepatientsopportunitiesforimprovement AT joefeinglass lowdensitylipoproteincholesterollevelsincoronaryarterydiseasepatientsopportunitiesforimprovement |